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Is Corticosteroid Therapy Effective for Sudden-Onset Sensorineural Hearing Loss at Lower Frequencies?
Shin-ichiro Kitajiri, MD;
Keisaku Tabuchi, MD;
Harukazu Hiraumi, MD;
Tomoko Hirose, MD
Arch Otolaryngol Head Neck Surg. 2002;128:365-367.
ABSTRACT
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Objective To assess the efficacy of corticosteroid therapy for sudden-onset sensorineural
hearing loss at lower frequencies.
Design Retrospective, nonrandomized, controlled study.
Patients and Methods The recovery rate, recovery/improvement rate, and period between the
start of therapy and improvement of symptoms were studied in 2 groups: the
control group, consisting of 36 patients treated with adenosine triphosphate
disodium, kallidinogenase, and cyanocobalamin between March 1, 2000, and January
31, 2001; and the corticosteroid-treated group, consisting of 42 patients
treated with corticosteroids in addition to the previously mentioned drugs
between April 1, 1997, and February 29, 2000.
Results No significant difference (P = .83) was noted
in the recovery rate between the control group (81%) and the corticosteroid-treated
group (79%), and the recovery/improvement rate was the same for the 2 groups
(83%). In addition, there was no significant difference (P = .84) for the mean ± SD period between the start of therapy
and improvement of symptoms between the control group (3.9 ± 2.7 days)
and the corticosteroid-treated group (3.7 ± 2.1 days).
Conclusion Corticosteroids were not effective for sudden-onset sensorineural hearing
loss at lower frequencies.
INTRODUCTION
SUDDEN-ONSET sensorineural hearing loss (SSNHL) at lower frequencies
can have clear causes, such as endolymphatic hydrops, but there are many cases
with unknown causes. These cases have been categorized as variants of SSNHL.
Treatment of SSNHL, including the low-frequency variant, has not been
established because the pathogenesis of this condition has not been clarified.1 Therapeutic methods, especially medication with corticosteroids
combined with some vasodilators, diuretics, histamine, plasma expander, carbogen
(5% carbon dioxide and 95% oxygen) inhalation, and/or calcium channel blockers,
have been attempted.1-2
Sudden-onset sensorineural hearing loss at lower frequencies has recently
been classified as an independent disease entity because of its good prognosis.2-3 This study was conducted to examine
the effectiveness of corticosteroids, which often cause serious adverse effects,
in the therapy of SSNHL at lower frequencies. Therapeutic outcomes were compared
between 2 groups of patients (those who did and did not receive corticosteroids).
PATIENTS AND METHODS
Between March 1, 2000, and January 31, 2001, 38 patients with SSNHL
at lower frequencies were treated on an outpatient basis, after obtaining
informed consent, with the following: oral adenosine triphosphate disodium,
300 mg/d; kallidinogenase, 150 IU/d; and cyanocobalamin, 1500 µg/d.
After excluding 2 patients who did not visit our hospital for follow-up, the
remaining 36 were included in the control group. Before March 1, 2000, at
Toyooka Hospital, Toyooka City, Hyogo, Japan, patients with SSNHL had been
generally hospitalized and treated with corticosteroid therapy (an intravenous
infusion of prednisolone sodium succinate at reducing doses of 300 mg/d for
3 days, 200 mg/d for 3 days, and 100 mg/d for 3 days) and the oral administration
of the same drugs as given in the control group, irrespective of the type
of hearing loss. The corticosteroid-treated group consisted of 42 patients
with SSNHL at lower frequencies who were hospitalized and treated with this
regimen between April 1, 1997, and February 29, 2000. The recovery rate, the
recovery/improvement rate, and the period between the start of therapy and
improvement of symptoms were compared between the 2 groups. The statistic
we used was  2.
Our diagnostic criteria of SSNHL at lower frequencies are as follows:
(1) SSNHL is of unknown origin, (2) pure-tone hearing levels at higher frequencies
(1000, 2000, 4000, and 8000 Hz) have no differences greater than 10 dB between
the right and left ears, and (3) the sum of pure-tone hearing levels at lower
frequencies (125, 250, and 500 Hz) is deteriorated by 50 dB or more on the
affected side than on the normal side. A glycerol test and, in some cases,
a magnetic resonance imaging scan was performed before starting the treatment,
and patients with positive results were eliminated from this study. Following
the evaluation criteria of hearing improvement established by the Study Group
of Sudden-Onset Hearing Loss, Japanese Ministry of Health and Welfare, we
evaluated improvement of hearing loss. Recovery indicates that the hearing
levels at the lower 3 frequencies are 20 dB or lower on the affected side,
or the difference of the mean hearing level at the lower 3 frequencies between
the affected side and opposite side is 5 dB or lower; improvement, the hearing
level at the lower 3 frequencies improved by 30 dB or more on average, although
the improvement does not fulfill the standard of recovery; and no change,
the change in hearing does not fulfill the standard of recovery or improvement.
There were no significant differences between the 2 groups for sex (P = .82), age (P = .98), affected
side (P = .75), period between the onset of hearing
loss and the first hospital visit (P = .95), or hearing
loss compared with the opposite ear (P = .76) (Table 1).
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Table 1. Demographic and Hearing Loss Variables in the 2 Groups*
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RESULTS
The recovery rate was 81% (29 of 36 patients) in the control group and
79% (33 of 42 patients) in the corticosteroid-treated group, with no significant
differences between the 2 groups (P = .83). The recovery/improvement
rate was 83% (30 of 36 patients) in the control group and 83% (35 of 42 patients)
in the corticosteroid-treated group, with no significant differences between
the 2 groups (P>.99). The mean ± SD period
between the start of therapy and improvement of symptoms was 3.9 ±
2.7 days in the control group and 3.7 ± 2.1 days in the corticosteroid-treated
group, with no significant differences between the 2 groups (P = .84) (Table 2).
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Table 2. Recovery and Improvement Variables in the 2 Groups*
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COMMENT
Sudden-onset sensorineural hearing loss at lower frequencies can have
clear causes, such as endolymphatic hydrops, but there are many cases with
unknown causes. These cases have been categorized as variants of SSNHL.
As for the cause of SSNHL, including the low-frequency variant, various
factors have been reported, including viral infection, vascular insult, perilymphatic
hypoxia, intralabyrinthine membrane rupture, and inflammatory and metabolic
causes, but none has been shown to cause all, or even most, cases of SSNHL.1 And there is not even universal acceptance of a standard
definition of SSNHL.1 Thus, treatment of SSNHL
cannot be established until the pathogenesis of this condition is clarified.1 Only corticosteroid therapy was reported to be effective
for SSNHL in a prospective, randomized, placebo-controlled study.4 However, several studies5-7
reported that corticosteroids were ineffective for SSNHL. Therapeutic methods,
especially medication with corticosteroids combined with some vasodilators,
diuretics, histamine, plasma expander, carbogen inhalation, and/or calcium
channel blockers, have been attempted.1-2
At Toyooka Hospital, patients with SSNHL, irrespective of the type of hearing
loss, had been treated with a combination of corticosteroids, adenosine triphosphate
disodium, vasodilators, and cyanocobalamin. It is well-known that corticosteroids
have serious adverse effects, including gastric ulcer, infection, diabetes
mellitus, shock, thrombosis, and infarction.
Sudden-onset sensorineural hearing loss at lower frequencies has recently
been classified as an independent disease entity because of its good prognosis.3, 8 Although the spontaneous recovery rate
is about 65% for all cases,1 the rate is about
80% for the low-frequency type.3, 8-9
This study was conducted to examine the effectiveness of corticosteroids in
the therapy of SSNHL (with a good prognosis) at lower frequencies. Therapeutic
outcomes were compared between patients who did and did not receive corticosteroids.
As a result, no significant difference was noted in the recovery rate between
the control group (no corticosteroids administered) and the corticosteroid-treated
group. The difference in the recovery/improvement rate was not significant
between the 2 groups. As for the period between the start of therapy and improvement
of symptoms, no significant difference was noted between the control group
and the corticosteroid-treated group. Therefore, corticosteroids were not
effective in the treatment of SSNHL at lower frequencies. A placebo group
may be needed to prove the ineffectiveness of corticosteroids, but we considered
it difficult to obtain informed consent from patients who would be included
in an untreated group.
Although adenosine triphosphate disodium, a vasodilator, and cyanocobalamin
were given in the control group, the recovery/improvement rate was 83%, almost
the same as the reported spontaneous recovery rate of SSNHL at lower frequencies.
Therefore, these drugs might not be effective in the treatment of SSNHL at
lower frequencies. To examine this hypothesis, a group of patients who do
not receive medication but who do receive placebo should be followed up.
To our knowledge, there are no established diagnostic criteria of SSNHL
at lower frequencies.3 Most studies3, 9 include patients with sudden-onset
hearing loss at lower frequencies and normal hearing at higher frequencies
in this category. However, hearing at higher frequencies deteriorates with
age. Elderly patients with SSNHL at lower frequencies may have hearing loss
at higher frequencies due to age-related deterioration in hearing. When these
criteria of normal hearing at higher frequencies are used, such elderly patients
might be excluded. We used the following criteria: the bone-conduction hearing
level at lower frequencies was deteriorated on the affected side compared
with the opposite side and no differences between the right and left ears
were noted in hearing at frequencies higher than 1000 Hz.
In conclusion, corticosteroids were not effective in the treatment of
SSNHL at lower frequencies. Further studies should be performed to establish
a treatment method for this disorder.
AUTHOR INFORMATION
Accepted for publication September 14, 2001.
Corresponding author and reprints: Shin-ichiro Kitajiri, MD, Department
of Otolaryngology–Head and Neck Surgery, Kyoto University Graduate School
of Medicine, Sakyo-ku, Kyoto 606-8507, Japan (e-mail: kitajiri{at}hs.m.kyoto-u.ac.jp).
From the Department of Otolaryngology–Head and Neck Surgery,
Kyoto University Graduate School of Medicine, Kyoto (Dr Kitajiri); the Tabuchi
ENT Clinic, Kobe City, Hyogo (Dr Tabuchi); and the Department of Otolaryngology,
Toyooka Hospital, Toyooka City, Hyogo (Drs Hiraumi and Hirose), Japan.
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